| NPI | 1790167146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001758) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 847207) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2025-01-30 |